ASHA 2011

Raising Awareness of the international need for treatment for communication disorders at the San Diego ASHA 2011 Convention in November.

Access the Powerpoint Presentation from ASHA 2011

Access the Powerpoint Presentation from ASHA 2011

If you were not able to attend the ASHA 2011 Conference, click on the above link to see the actual Powerpoint shown.

BRINGING EVIDENCE-BASED AUTISM EDUCATION TO BOSNIA: A MODEL OF SUCCESS

Coauthors:

Anna Taggart, M.S. CCC-SLP and Amanda Adams, Ph.D., BCBA

Access the Powerpoint Presentation from ASHA 2011

Access the Powerpoint Presentation from ASHA 2011

If you were not able to attend the ASHA 2011 Conference, click on the attached link to see the actual Powerpoint shown.

BRINGING EVIDENCE-BASED AUTISM EDUCATION TO BOSNIA: A MODEL OF SUCCESS

Coauthors:

Anna Taggart, M.S. CCC-SLP and Amanda Adams, Ph.D., BCBA

Bringing Evidence-Based Autism Education to Bosnia: A Model of Success

This was the Proposal Summary given at the American Speech Language Hearing Association (ASHA) Convention in San Diego, CA in November 2011.

“In the summers of 2009 and 2010, volunteer teams of SLPs, medical practitioners, and special needs teachers from the San Francisco Bay Area, along with Behavior Analysts from California State University-Fresno, went to Bosnia to train parents, professionals, and university students about autism diagnosis and treatment. The two-week practical training seminars, held in Sarajevo in 2009 and repeated in Tuzla in 2010, incorporated theoretical training and hands-on work with community children who had been identified as having autism.

Using the National Standards Project, published by the National Autism Center, as a guide in choosing which evidence-based strategies to train in Bosnia, the teams developed five days of lectures comprised of the basics in autism diagnosis and treatments.  The lectures were open for families of children with autism, the medical community, teachers, psychologists and speech-language pathologists to attend. Each year there were over 300 people from Bosnia and neighboring countries in attendance.

For the second phase of training, a small group of professionals were chosen to take part in a classroom-based, real-life training experience in which they could learn to apply some of the treatments discussed as part of the theoretical training. The Bosnians were ultimately identified because they had: 1) attended the previous five-days of lectures, and 2) either had already been serving the autism population in their local communities or were hoping to serve autism in the future. In the two years the seminar was held, 34 professionals were trained.

The classroom spaces themselves were donated by the local governments of Bosnia, and all materials, educational items and furniture were either donated through a non-profit organization in the U.S. and brought to Bosnia by the American professionals in suitcases, or purchased while in Bosnia. The classrooms where training occurred were designed using the TEACCH model, and were the first of their kind in the country.

Children between the ages of 2-6 years old were identified by local autism parent associations, and invited to participate in the classroom experience. In 2009 there were 8 children identified who met the age criteria and participated in the classroom training, and in 2010 there were 9 children who participated. It was believed that hundreds more children with autism may exist in those large communities, but because of cultural and socio-economic factors, many children with autism were reported to be either hidden in the homes or abandoned in institutions. The majority of the children who participated in the classroom training had no previous school or classroom experience.

For educational consistency, each child was paired with two Bosnian professionals for duration of the 5 days of classroom experience. However, using a center-based, rotating classroom schedule, each child and pair of Bosnian “teachers” was able to work with all of the American professionals in their varied areas of expertise. As the practical training experience progressed across the five days, the American trainers faded their assistance until the final day, when ultimately the Bosnian professionals were running the classroom independently.

In just five days, the Bosnian professionals, with the American trainer’s assistance, had the classrooms running smoothly and children were making progress on a number of goals.

Progress for children was measured by a simple system of data collection in areas such as inappropriate behaviors, language/ communication, and social interaction. To monitor the progress and learning of the Bosnian professionals, a self-reporting interview system was used.

In summary, a two-week training offered in Sarajevo, and then in Tuzla the following year to different children and professionals, resulted in a total of 34 professionals, university students and professors being trained in the basics of autism intervention. Additionally, seventeen children and families from those two citied participated in the experience. Inappropriate behaviors decreased to near zero levels, preliminary communication and language goals had been established and behavioral intervention goals were developed. Incredibly, each of the 8 children who participated in 2009, and the 9 children who participated in the 2010 week-long program made measurable, albeit preliminary progress across a number of areas. 

In as little as three years since the first seminar was conducted in Sarajevo, Bosnia has undertaken sweeping changes for autism education and treatment across the country.  There are now two official “schools” established in Bosnia’s larger cities to treat autism, with some satellite centers developing in smaller towns and villages. The professionals who were trained continue to report their successes in their current places of employment, as well as with individual children. Families are organizing into support networks and providing resources to the general population to educate and increase awareness of autism.

This presentation will discuss in detail how a collaborative model for treatment can be implemented with highly structured yet minimal staff training. Participants will understand the content of the two-week trainings and the model for the classroom which relied heavily on applied behavior analysis and speech-language interventions.”

Tuzla Classroom Summary

Hello again! We apologize for neglecting this blog for so long. In reviewing the information, it even came to our attention that a summary of the 2010 classroom was never posted, yet one was written. See below for the perspective of Marty Smith, a SPG: CSI 2010 Volunteer.

 

Hello! I’m Marty Smith.  I just finished my undergraduate degree in speech-language pathology/audiology at the University of North Texas.  Lacking the extensive clinical and educational experience of my fellow team members, I was privileged to learn from them and especially from the local professionals in this field.  These teaching interactions speak to the complexity of a project like this one: within our limited timeframe, we worked at teaching the local professionals and not as directly at working with the children.  This made the open social, academic, and work-related conversations with local professionals expotentially more rewarding.

There are so many stories that we could relate about this classroom week, so I can only try briefly to tell a few that stuck out for me.  One young child, after being prompted repeatedly to use PECS to indicate his needs, told his therapist: “I know speak.”  Another came to us in such a shy and reserved manner that only imitating us, smiling, and laughing was a cause for teary-eyed celebration.  An older student smiled continuously, seeming to keep a secret from us, even as he reveled in the sensory room, delighting especially in the ball pool.

This experience was beyond what words can explain, and I have no doubt it will make a lasting impact on my life and so many others. See the SPG: CSI website for pictures of our experiences. spgcsi.org

Day 3 in the Classroom

Enjoying outside playtime

Zdravo (Hello)! My name is Sarah Lobegeiger. I am an Australian who is completing a graduate program in Speech and Language Pathology in Melbourne, Victoria.

Reflecting on yesterday, even now after some hours of sleep, I am enthused to think of what today will bring. Such gains have been made in the classroom. Given that I am not assigned to a specific station or child I have the privilege of moving from time to time through the stations. Thus my mind is full of snippets of success: Glimpses of a child smiling and laughing in floor time while the local professional kneels beside them and engages them with a toy, the joy on a clinician’s face when a child learns how to request using a PECS card, the mural on the wall in the language area that features cut out flowers with a picture of each child’s face at the centre that each child has pasted, some independently others with the help of the clinicians.

Yesterday at the end of class time, the international and local professionals gathered together in a large circle and gave feedback. We were asked to share with the group what our highs and lows have been. This time provided an incredible chance to reflect on the progress the children have made since it gave us all the opportunity  to see the collective gains of the group at large. Local professionals shared their growing faith in the ability to effect change through behavioural intervention. Some mentioned that at the beginning of the week addressing problem behaviours and approaching a child with ASD seemed out of their scope. They expressed an increased confidence now in their own ability after developing vital problem solving skills and a fresh approach.

Unprecedented improvements were reported for many of the children on day 3. Parent reports from the local staff were also mentioned. One child is now removing his shoes at home and putting them away, another can hardly wait to come to school. One clinician stated how her goal for the day had been to have her child look at her just once. She spoke with passion, “I just wanted him to look at me and I would not give up. I tried everything.” We all listened with bated breath as she talked about her goal. She told us how her child had minimal interaction with her and she had been eager and determined to see this gain. In the sensory area while rolling on the carpet and playing with balls no progress was noted. At class time, once more nothing. Snack time and no eye contact or significant interaction still. By the time it was outside play, despite her whole-hearted attempts, the goal was not achieved. But then a breakthrough was made. The clinician knelt on the floor at floor time and tried everything to engage the child. She lead him to the felt board and summoned for him to come to. As she played with the coloured animals and wriggled them in front of his face, he looked her straight in the eye and offered a fleeting smile, then a giggle. I was there at the time and saw this occur. I had not realised the context or that this had been her goal for the day, but I do remember that at that moment I had been given a co-worker’s camera to take photos. I had been trying to capture this clinician’s face and her interaction with the child. I recall making a mental note at the time that I should really take more photos of the mentioned clinician since she had such a wonderful smile when working with the kids. Yet to know what brought that smile on, to understand the struggle and problem solving she had used to elicit interaction, made the smile even deeper.

Its early in the morning and the buzz of traffic is already beginning under my hotel window. The sun has not yet seeped through the fog and cloud that has been collecting over the hills most mornings in Tuzla. The mornings never give away what weather is in store. But I am pretty convinced that the memory of yesterday conceals nothing. Today we will have new successes and challenges in that classroom. New gains are waiting to be made. I better get out of my pajamas and get ready for it!

Greetings from Bosnia

Hi! This is Ginny Preston, an SLP from Berkeley, who works with the Speech Pathology Group.  We are here in Tuzla, Bosnia training educators to work with autistic children.  All last week,  a seminar was held under the direction of Anna Taggert.  Several members of our team presented evidence-based practices used in working with this population.  Other team members made home visits to the families of autistic children.

Today, we opened a classroom that serves nine autistic children.   All the 11 team members, plus 18 Bosnian professionals were there to greet the students. After the expected tears from students who were entering a strange environment, the real work began of teaching new tasks, shaping behaviors, and providing support.  Parents were given a much-deserved three hours to themselves.

At the classroom area, students put objects into containers, sorted by color, worked puzzles, and built towers of blocks.  In the sensory area, students could choose to crawl through a tunnel, throw a ball through a basketball hoop, place velcro-backed animals on a large farm scene, or squeeze soft, spiky balls that lit up.  After snack and outside play, the students rotated through four stations: Discreet Trial Therapy where they were taught to focus attention on discriminating pictures;  Picture Exchange Communication System (PECS) where they worked on using icons to request items;  Floortime where the children showed interest in play and teachers followed their leads in order to build relationships;  and Language where students traced their names and used play-doh to form letters in their names.

Activities will vary each day, but the purpose always will be to provide experience to Bosnian educators who will then use these principles in their own teaching.  One group of Bosnian professionals will take over the classroom after the SPG-CSI team leaves.  More on the successes of the classroom later

For additional information on the work of SPG-CSI in Bosnia, please go to the website,  www.SPGCSI.org.

Anna Taggart presenting lecture

Hello to all reading this. My name is Joey Wagoner. I am part of the home intervention and class room team here in Tuzla, Bosnia.  I have been studying treatments and working with children diagnosed with autism for over two years now, as well as being personally affected by having a 14 year old brother who has been diagnosed with Autism.

Today marks the end of the team’s third day in Tuzla. Although one can observably see the team beginning to be affected by the lack of sleep and rest, it is still just as easy to see the spirits radiating from the team. The tone of their voices; the laughter that accompanies the end of a story; the emotion that is unleashed into every verbal behavior that occurs, shows every team member’s dedication to not only this project itself, but to the families and overall goal of what we are accomplishing. Regardless of how prevalent and understood it is in certain countries, people all around the world are effected by this developmental disorder. Some people hear about it from the news. Some hear about it from a friend, interpret the information, then go about their day. That is not how it is for the families here, or for that matter any where else in the world. Autism affects the child and family from the moment they open their eyes until the moment they lay their head down at night to receive some well deserved sleep. People who live with this disorder live a lifestyle that one can only understand at a surface level. To understand the full emotional pull and drainage it has on faimilies, you have to start from the beginning.

For example, one family that I personally visited today have a 15 year-old teenager who was diagnosed with autism at the age of two. They had received a minuscule amount of occupational and language therapy for him, but due to unforeseen roadblocks, it unfortunately had to halt. This child, beautiful, intelligent, and kind-heated, experiences something that we can only fathom. The parents bring a new definition to the word dedication. They feel; they provide; they put all that they can put into their child so he can be content and happy. I accompanied Dr. Marianne Jackson from California State University Fresno to this family encounter. Upon our initial arrival, we could immediately sense that we were not entirely welcome in the home. Although the family provided us with turkish coffee, juice, and a type of cake that can make you savour for more merely by bringing it into a state of awareness, we all felt a certain amount of skepticism.

We were here to implement a treatment that is not well known here in Bosnia. And even what is known of it may have been projected in a bias manner due to subjective interpretation of an unknown treatment. They knew we wanted to help, but they were unsure of if we would really be helping. But this is understandable; parents, even if providing ineffective treatments, are none the less providing something because they care and want to implement a change not only for their personal life, but for the life of their child that they care so deeply about. But…back to the story at hand. After greeting the family, we interacted with the child, who was even more unhappy to see us then the parent. He didn’t know who we were, but he knew we were here for him. We engaged minimal with the child to avoid in SIB (self-injurious behavior), which began to occur once he figured out our purpose in his household. But once we engaged the parents and told them what we were there to do, you could see a change in their behavior. Their arms began to unfold; they began to lean forward in anticipation of what was coming next; smiles began to appear in such a manner that it brought about smiles to all the people in the room. As well, you could see bonding taking place between the parents themselves. A recent statistic showed between 75-80% of parents who have children with autism end up getting a divorce. This disorder affects every aspect of the families life, even the love they have for one another. But these parents have what it takes. They began to slowly implement some of our suggestions…….and it worked. The child decreased their SIB’s and was engaging with the parent in an appropriate manner by the end of only a two hour session. You could not only feel the joy radiating from the parents, who held each other so lovingly, but even from the team members who were there, as well as myself.

By the time we left, we had developed such a rapport with the parents that next time I don’t see any trouble being welcome back in their home. As well, the mother had gone to the seminar in the morning (which had Speech Pathologists and Behavioral Psychologists speaking to a crowd of nearly 100 people who consisted of psychologists, speech pathologists, and parents about the effectiveness of Applied Behavior Analysis, Speech and Language Pathology, and Sensory Integration) and then rushed back to our visit to their home to see what was talked about in action. As well, she reported she would be going again tomorrow then rushing back for a final home visit with their family. Although that may not spell dedication itself, I don’t think a Webster Dictionary could provide a better definition.

Autism in Tuzla Day 2

I am writing this blog on Tuesday night, Bosnian time. It is the end of day 2 out of a two week experience. SPG: CSI has come to Tuzla to accomplish 3 specific goals:

1) Co-host a 5-day seminar presenting evidence-based treatment and diagnosis information about the autism spectrum disorders

2) Meet with 10 families in their homes, determine the goals for their child, model treatment interventions and leave the family with programs that can be followed in years to come

3) Open the second classroom in Bosnia for preschool children that incorporates effective interventions for children with ASD. This classroom is intended to be used as a training center for university students and professionals from throughout northern Bosnia.

SPG:CSI intends to meet the goals by having a multidisciplinary team of 11 people from all over the US and Australia present imperative information to professionals and parents in a vaiety of formats.

For those of you who have been supporting SPG:CSI, these goals are not news to you. We have been in the process and planning stages for over one year. So let me, as the President of CSI and the fortunate team leader for these amazing professionals, tell you what has happened in only a very short time.

I met the team upon their arrival in Zagreb, and we began the journey to Tuzla together. As expected, people were tired and hungry, but they came with smiles and full of hope. We arrived on Saturday night. The hotel we are staying in is in a perfect location- close to the classroom and close to downtown restaurants. We share our grievances about the lack of hot water, the intermittent internet access, and cramped quarters, but we do so with a light heart. We know why we are here, and our purpose is greater and will give us more than what these acommodations can weigh us down.

Day 1: We began the day with little sleep. The night before we all laid in bed quietly, silently, while our minds raced about what was to come in the next two weeks. Would we have enough to give to the parents and children in Bosnia? Were we qualified enough to be here, to present such vital information, to work with children with such extreme needs? Would we be able to meet the needs? We are only ordinary people, with ordinary lives in the U.S., but somehow here it seems we need to be more! Do we have what they need?

At 8am we left our hotel to begin our various jobs. Some people left in small teams, paired with University students, to make home visits. There are three teams seeing a total of 10 families, for three visits each. On day one the goal is to identify the needs of the families, the goals for their children, and begin to implement effective intervention to help the families meet these goals. Most of the children are over age 10 years, and their goals include potty training, using a spoon to feed themselves, or learning to say their first words. Fortunately, we have a team of behavior analysts, speech therapists, psychologists, and sensory-based professionals ready to tackle any goals that the parents may want.

For the Family intervention team, their first day was filled with emotion. By the end of their first visit, all of their initial trepidations were gone. The families in Bosnia are incredibly receptive to learning new ways to teach their children, and are grateful to have us in their home. We are equally grateful that they allow us to share in their journey of autism.

Personally, my highlight of day one was when I got back to the hotel at the end of day one and I spoke with one of the professionals who had been to see a family in the home. He and the University students were talking about how exciting it was to go in the homes, to meet the kids and to begin intense training on essential skills. Then I hear Eduardo say, “Anna, we need to buy a toilet.”

??? What? We need to buy a toilet? Why?? Eduardo begins to tell the story of a 17 year old boy who lives in a home where the toilet is located outside the main home, and is what we consider a “turkish toilet”. Essentially, it is a hole in the floor. The child can go “#1″ in this toilet, but he does not have the core body strength to hold himself upright to go “#2# in the turkish toilet. The family has chosen potty training as their number one goal. If the child can be fully independent in toileting, then the mother and father will be free to run daily errands and other essential tasks, and the 17 year old will not have to wear a diaper.

Currently, the mother waits at school during the hours her child is there in order to help her son go to the toilet. The school will not help the family potty train this young boy, and when considering his future, it is very bleak. There is no family freedom, and this child will never be fully independent unless he learns to go to the toilet alone.

So when Eduardo says to me that we need to buy a toilet, I was aghast! A toilet is not in our budget. A toilet is not something we have considered as a goal. A toilet is not anything I have ever had to consider as part of my profession! But nonetheless, if we buy a western toilet, the child will certainly learn to use the bathroom independently. So as a team, we began the 2 day search for a western toilet installation for this family. I will let Eduardo and the rest of the team explain the rest of the toilet story. For now, I can tell you that we have a temporary fix and tomorrow the potty training begins in earnest.

Day 1 continued: For those of us on the Seminar team, we began our day with excitement and fear. At 9am we had a press conference in which 3 TV stations and 4 radio stations were present. In addition, we were placed directly in front of the Vice President of Bosnia and her cabinet, as well as the Minister of Education, the Minister of Social Politics and Labor, and representatives from every level of government in Bosnia. We had coffee together, we smiled and shook hands in front of the audience, and we did our very best to represent SPG:CSI and all the people affected by autism.

At 9:30 am, the seminar began. We met people who came from Serbia, Montenegro, Croatia, and other ex-Yugoslav countries for our presentations. Even though they traveled far and wide, some people in the audience initially looked at us with hesitation and mistrust. Our panel of experts knew the information we were giving was the most up to date and reliable information in the field of autism, so we began the seminar with confidence. In the first few presentations there were very few questions, which indicated that people were not ready to connect with us. Day one went by without a problem, but we all left feeling like we needed to somehow break through the barriers that separated us.

Day 2:

Home visits continued. The search for the toilet continued. The suitcases that carried the toys and materials were emptied, the toys were out on the shelves, and the name tags were placed. The classroom needed only a few more hours of work before it was really ready for children to come. We have until next Monday. Stay tuned.

The seminar was incredibly successful.There was standing room only. We had double the attendees that were expected. As a matter of fact, at lunch we ran out of food because so many people came that were not expected. We must have gotten through to them on day one more than we knew.  Over 90% of the audience had made a connection with the speakers by the end of day one. When I told the “Welcome to Holland” story (feel free to Google this), there were tears in the eyes of many people, mostly parents. Maybe this is when they began to trust us. When Dr. Jackson presented part one of ABA, the professionals applauded and gave her high-fives. Tomorrow can only bring more successes!

Day 2 continued:

Home visits were emotional today. One particular child, who has been the focus of many professionals, has an intense preoccupation with cutting paper or cloth. She does not know how to use scissors and so she uses knives. Although she is an adolescent and almost fully grown in the physical sense, the problem with her using knives is that she is self-injurious and has had instances of aggression towards her family. If she has learned to hurt herself or others for attention, or to get what she wants, what could happen when she learns the full power of a knife?

The family was sure that removing her knives would result in a full out battle that would result in her screaming or hurting herself. When we asked if we could try to teach her new skills and get the knives away, the family stated that they did not think it would be successful but that we were welcome to try. Everyone stood back and held their breath. In a matter of a few minutes, our team was able to remove the knives from her and teach her how to use scissors. By the next visit, the child and the family should be safe and blunt-tip scissors will be the child’s new best-friend.

It is the small successes here that matter. It is when we connect with the people and hear their stories that we feel we are part of a larger, global family. It is then that we know we have a responsibility to give something back to the world in need.

Our team has shared their fears, their hopes, and their joys. We have cried together (and its only Tuesday!!!), we have laughed together, and we continue to learn from each other. Day 3 promises to be even better.

I cant wait for you to hear all that is happy and joyful, sad and scary, and all that is SPG:CSI in Tuzla 2010!!!

Good night!

The Final Countdown to Tuzla 2010

With only a few days to go before we kick off the 2010 Bosnia Autism Project, I wanted to give our supporters some very exciting updates!

The volunteer team arrives Saturday afternoon in Zagreb and then will travel by bus, finally arriving in Tuzla on Saturday night. SPG: CSI team 2010 has spent the last year preparing for the next two weeks. We have 11 professionals coming from all across the US and Australia ready to put in action all they have dreamed about until now. Even though they will arrive exhausted from the journey, I have no doubt the excitement of finally being able to meet the children and families will be energizing!

Regarding the seminar we are co-hosting with the University of Tuzla, which is called  “Autism: Our Reality”, we will be speaking on topics related to the treatment and diagnosis of Autism Spectrum Disorders (ASD) for the first 5 days. We were expecting to train 100 people each day, but yesterday I heard that we have more than 140 who would like to come on day one alone. Standing room only- I am so happy people are so interested! HOORAY!!!

While we have the seminar team speaking at the Hotel Tuzla, the Family Intervention team will be making home visits to families and children in the community. We are scheduled to work with 10 families in one week, with teams of professionals and University students seeing each family 3 times. The Family Intervention team has established goals individualized to each family, and at the end of their visits they will have provided each family with a home education, communication, and/ or behavior plan.

After we finish the first week of the theoretical training and home visits, we will begin practical training in the new Tuzla Kindergarten for children with ASD. We will have nine students in attendance from the local community, and we will provide intense training to 18 professionals and University students who will come from all parts of Bosnia. The long-term purpose of this classroom is for it to serve as a training center for other professionals in the future, and provide a place for University students studying speech-language pathology and special education to receive hands-on training prior to graduation.

Wonderful news for those of you who have been following our progress: The classroom is ready! The furniture has been assembled, the walls have fresh paint and the grass has been cut…it is just waiting for students to make it complete. Even the neighbors are now asking when the children will arrive!

We are looking forward to June 21st which is the first day of the seminar and home visits, and June 28th which is the first day of the classroom practical training.

Follow our blog to receive new updates and see pictures of SPG:CSI in action in 2010!